Page 117 - Clinical relevance of current materials for cranial implants

Large studies on autologous cranial grafts report failure rates up to 40% due to
resorption or infection (defined as an infection requiring removal of the bone graft)
27,40-43. Resorption did not occur with PEEK cranioplasty. The infection rate in our series
(defined as the invasion and multiplication of micro-organisms that are not normally
present within the body) was 13%, which is comparable to the reported infection rates
after autologous and allograft cranioplasties10,22,27. In line with the literature, S. aureus
appeared to be the most common pathogenic microorganism44-46. Although infection
rates in this study were comparable to infection rates after autologous cranioplasties,
PEEK has the important advantage of the possibility to be repeatedly sterilized with no
significant changes in its mechanical behavior37. Therefore most of the implants could
be replaced after a period of time and final loss was only recorded in two patients who
refused re-operation (5%). 5
Patient characteristics
A non-significant, but positive relation between age, vascular comorbidities, smoking behavior and complications was found in our study. A relationship with other medical comorbidities was not found. The association between age and complication rates is well known47,48. Conflicting results on associations with medical comorbidities have been reported in the literature27,40,48.
With regard to the initial indication for craniectomy, stroke patients were more likely to get complications after PEEK cranioplasty; this is consistent with literature findings and most likely reflects age in combination with (vascular) comorbidities47,48. Remarkably, cranioplasty in tumor patients was associated with a trend towards a lower infection rate, which contrasts to the literature reporting higher complication rates in tumor patients due to perioperative corticosteroid treatment, nutritional problems and chemo- and/or radiotherapy22,47. Tumor patients in our series however had a meningioma and did not receive chemotherapy nor radiotherapy.
PEEK cranioplasty
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